Circulatory effects of central neurological failure

Systemic hypertension with sinus bradycardia (Cushing's response) indicates compression of the medulla oblongata caused by herniation of the cerebellar tonsils through the foramen magnum. This is a late and pre-terminal sign.

Summary: the rapid clinical assessment of an infant or child

Airway and Breathing Effort of breathing Respiratory rate/rhythm Stridor/wheeze Auscultation Skin colour Circulation Heart rate Pulse volume Capillary refill Skin temperature Disability

Mental status/conscious level



The whole assessment should take less than a minute

Once airway (A), breathing (B), and circulation (C) are clearly recognised as being stable or have been stabilised, then definitive management of the underlying condition can proceed. During definitive management reassessment of ABCD at frequent intervals will be necessary to assess progress and detect deterioration.




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